SPRINGFIELD – Cardiovascular disease has many risk factors, including age, gender, and family history, none of which is in our power to change.
"In safeguarding our cardiovascular health, we need to focus on risk factors that we have influence over, things like smoking, diabetes, high blood pressure, kidney disease, sleep apnea, living a sedentary lifestyle, and cholesterol," Baystate Medical Center cardiologist Dr. James Kirchhoffer of the Heart & Vascular Program, said.
High blood cholesterol is one of the major risk factors for heart disease and the number one killer of men and women in the United States. Many risk factors contribute to having high or low cholesterol, including heredity, diet, lack of exercise, excess weight, age and sex, alcohol and stress levels. Also, racial and ethnic minorities, including African Americans and Hispanics, are at greater risk for developing high cholesterol.
National Cholesterol Education Month in September serves as an important reminder for all adults to have their cholesterol measured through a simple fasting blood test, to know their cholesterol numbers and their risk for heart disease, and to follow a heart-healthy lifestyle to lower their risk and keep it down, noted Dr. Kirchhoffer.
"At one time we only thought about cholesterol for adults over the age of 35, but no more. The epidemic of childhood obesity and diabetes has pediatricians and family doctors checking cholesterol at younger ages depending on risk factors and family history," Kirchhoffer said, who noted the U.S. Department of Health and Human Services recommends that everyone age 20 and older get their cholesterol measured at least every five years. Patients with coronary artery disease, diabetes, or peripheral vascular disease will need to have their cholesterol levels checked more often. And, patients already being treated for high cholesterol will usually be checked more often and should also be screened for diabetes.
Cholesterol is a waxy substance used in making the walls that surround cells and in making a number of hormones used in human metabolism. Some cholesterol comes from the liver and other cells in your body, other cholesterol comes from food. For some, high cholesterol is inherited, but many times it is the result of eating too many trans fats, saturated fats, and dietary cholesterol from animal products.
There are two types of cholesterol: "good" and "bad." When blood contains too much of what is referred to as LDL cholesterol – the so-called "bad" cholesterol – it can build up in the artery walls. If the buildup is gradual, the arteries harden and become narrow, resulting in angina, which is chest pain or discomfort when your heart muscle does not get enough blood. If the buildup is rapid, or a blood clot occurs at the site of the narrowing, there may be sudden closure of the blood vessel – a heart attack.
Cholesterol travels through our bloodstream with the aid of a lipoprotein, which is a combination of proteins and cholesterol. There are two types of cholesterol – LDL and HDL – determined by which one the lipoprotein carries. LDL stands for low-density lipoproteins, otherwise referred to as "bad cholesterol," which deposits cholesterol in the blood vessels, forming plaque and increasing one's risk of heart attack and stroke. HDL cholesterol stands for high-density lipoproteins, considered to be the "good" cholesterol, which remove cholesterol from plaque and out of the bloodstream through the liver.
As for desired levels, for LDL the lower the number the better, and there does not seem to be a level that is too low, noted Dr. Kirchhoffer. Depending on risk factors such as coronary disease, other blood vessel disease, diabetes, hypertension, smoking, and kidney disease, LDL goals are less than 130 for everyone, less than 100 for those with one risk factor, or less than 70 for those with more than one risk factor. HDL levels should be more than 40 or 50, and are mostly determined by genetics and lifestyle. HDL less than 40 is a risk factor for blood vessel disease, while HDL over 60 may reduce the risk of heart attack and stroke.
"I can't stress enough the importance of lifestyle modification when it comes to lowering your cholesterol. My personal favorite four-word mantra is 'Eat Less, Move More,'" said the Baystate cardiologist.
Red meat and the saturated animal and dairy fat that go along with it can put your arteries to the test. The American Heart Association advises limiting your red meat to two, 4 oz. servings weekly. The AHA also recommends a diet rich in vegetables, fruits, whole grains, high-fiber foods, lean meats and poultry, fish at least twice a week and fat-free or one percent dairy products - and low in saturated and trans fats and cholesterol. Aerobic exercise is also important. Most guidelines recommend 30 minutes daily of aerobic activity, such as walking, running, biking, or swimming.
"More is better, and there are very few of us who do too much exercise. Adding resistance training for 20 minutes, two or three times each week, is also in the guidelines, and helps with general fitness and bone density," Kirchhoffer said.
When diet and exercise fail to reduce high cholesterol levels, doctors turn to a type of drug known as a statin. Statins are generally classified as either low potency or high potency. Rosuvastatin (Crestor) and atorvastatin (Lipitor) are high potency, as is simvastatin. Pravastatin, lovastatin, fluvastatin, and pitavastatin are lower potency. The decision to prescribe one statin over another is frequently based on cost and what your health plan will allow. Depending on your cholesterol levels, risk factors and clinical situation, your doctor may decide on a low potency or high potency statin. The dose can then be adjusted or the medication changed to ensure it is achieving the desired results. Generic statins are seeing wider use, and are generally less expensive and just as successful in lowering LDL.
"While statins lower LDL and reduce the risk of heart attack and stroke, no medication to date has raised HDL resulting in reduced risk, although niacin, also known as vitamin B3, may be helpful in some situations," Kirchhoffer said.
Baystate Medical Center offers a Lipid Management Program for patients interested in guided help in making the right lifestyle changes to lower their cholesterol.
The program is staffed by an experienced and supportive team of cardiologists, an endocrinologist, a nurse practitioner, and a registered dietitian, who specialize in evaluating and treating people with high cholesterol. Participants are tested for their lipid levels and receive counseling from a team on lifestyle changes and medicine that can lower their levels to a heart-healthy range. Patients must obtain a referral for the program from their primary care physician.
For more information on Baystate Medical Center's Lipid Management Program, call 794-0849 for more information on the hospital's Heart and Vascular Program, visit baystatehealth.org/heart